How does Africa fare? Findings from the Global Burden of Disease Study

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The Global Burden of Disease Study 2010 (GBD 2010), a systematic effort to assess the global distribution and causes of major diseases, injuries, and health risk factors, was launched last week in London.

What are some of the main findings for Africa that can be drawn from the GBD 2010?

Since 1990, the largest gains in life expectancy worldwide occurred in sub-Saharan African countries, especially in Angola, Ethiopia, Niger and Rwanda, where life expectancy increased by 12-15 years for men and women. Overall, male life expectancy increased from 48.8 in 1990 to 53.2 years in 2010 in central sub-Saharan Africa, 50.9 to 59.4 years in eastern sub-Saharan Africa, and 53.0 to 57.9 years in western sub-Saharan Africa. Among women, life expectancy during the same period increased from 54.3 to 58.5 years in central sub-Saharan Africa, 54.9 to 62.6 years in eastern sub-Saharan Africa, and 56.5 to 60.9 years in western sub-Saharan Africa. In the case of southern sub-Saharan Africa, largely due to the heavy toll imposed by HIV/AIDS, life expectancy declined from 60.6 to 55.7 years among males, and from 67.7 to 60.6 years among females.

The declines in mortality rates in Africa that are summed up in life expectancy at birth were largely the result of scaled up and effective programs to control HIV/AIDS (e.g., increased coverage with antiretroviral drug therapy) and prevent childhood diseases (e.g., interventions to control malaria, such as insecticide-treated bednets and artemisinin-combination therapies).

All four sub-Saharan African regions have had at least a 10% decline in adult mortality from 2004 to 2010.

Deaths among children under five years declined in 25 countries in west, east, and southern sub-Saharan Africa. As noted in a recent blog by Gabriel Demombynes and Ritva Reinikka (http://blogs.worldbank.org/africacan/africas-success-story-infant-mortality-down), this is a tremendous success story in Sub-Saharan Africa that needs to be recognized. But, as more children survive to adulthood and the mean age of death increases, policy makers need to place greater attention on the prevention of young adult deaths (aged 15-49 years).

While substantial progress was achieved in Africa in reducing years of life lost due to premature mortality (YLLs) from communicable, maternal, neonatal, and nutritional causes, these conditions still account for three out of four premature deaths. At the same time, as shown in table below, deaths from non-communicable diseases such as cerebrovascular diseases and road traffic injuries have emerged as leading causes of years of life lost. The latter fact is clear evidence of the double burden of communicable and non-communicable disease that now characterizes the health profile in sub-Saharan Africa.

In 2010, nine of ten countries with the lowest male healthy life expectancy (HALE) and eight of ten countries with the lowest female HALE were in sub-Saharan Africa. This in large measure reflects the impact of the HIV/AIDS epidemic that erased years of life expectancy at the population level. Besides age-specific mortality, HALE also captures the impact of living with illness and disabilities, and highlights their growing importance for health and social protection systems.

In terms of non-fatal health outcomes from diseases and injuries, the leading causes of years lived with disability (YLDs) in sub-Saharan Africa are neglected tropical diseases (schistosomiasis, onchocerciasis, African trypanosomiasis, and hookworm), HIV/AIDS, tuberculosis, malaria, and anemia (particularly caused by tropical diseases and iron-deficiency anemia). Mental health conditions such as depressive and anxiety disorders, as well as alcohol abuse in some countries, are also leading causes of YLDs in this region.

Although the share of disease burden in central, eastern, and western sub-Saharan Africa attributable to childhood underweight, household air pollution from solid fuels, and non-exclusive and discontinued breastfeeding have fallen substantially, these three risk factors continued in 2010 to be the leading causes of disease burden. However, as differing from other subregions in Africa, for the southern sub-Saharan Africa region, alcohol abuse is now the leading risk factor, followed by high blood pressure and high body-mass index, signaling a shift from risk factors for communicable to non-communicable diseases and injuries. Alcohol abuse not only increases the risk of road traffic injuries and other injuries, but also of tuberculosis, which cause a large proportion of disease and injury burden. Tobacco smoking, including second-hand smoke, is also a leading risk factor for disease in sub-Saharan Africa.

Overall, the findings of GBD 2010 convey some good news for sub-Saharan Africa, but they also point to emerging challenges in the region, particularly arising from the double burden of communicable and non-communicable diseases, preventable road traffic injuries, and related risk factors at both population and health system levels. And, as noted by Lancet editor Richard Horton, the global health community, including governments, research institutions and international agencies, need to make a major commitment in the years ahead to “improve the measurement of health” by strengthening civil registration and vital statistics systems as a development priority building upon the “energy and momentum” generated by GBD 2010.

As we learn more from the “data-rich framework” offered by GBD 2010 to better understand the changing disease, injury and health risk profile in Africa, it would be important to also keep in mind World Bank President Jim Yong Kim’s observation that the value of this study “lies not only in the data but the critical discussions it makes possible” at country and regional levels for policy making and practice.